• Christopher J DeWald and Thomas Stanley.
• Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. orthoscoli@aol.com
• Spine. 2006 Sep 1; 31 (19 Suppl): S144-51.

Study DesignRetrospective follow-up of patients over the age of 65 with a minimum of five-level fusions.ObjectiveTo determine the effect on outcomes of long constructs in patients with poor bone stock, and to review surgical techniques used in patients with poor bone stock.Summary Of Background DataScoliotic deformities in patients with poor bone stock require alterations in both the surgical technique and preoperative planning. To our knowledge, complications of long constructs in poor bone stock have not been specifically reported.MethodPatients over the age of 65 that underwent a minimum of five-level fusion over a 5-year period were reviewed. We reviewed both operative reports and clinic notes and recorded both early and late complications.ResultsEarly complications included pedicle fractures and compression fractures with an overall rate of 13%. Late complications included pseudarthroses with instrumentation failure, adjacent level disc degeneration with herniation, compression fractures, and progressive kyphosis. Progressive junctional kyphosis occurred in 26% of patients.ConclusionsSpinal stabilization surgery in patients with poor bone stock is associated with high complication rates. Complications such as progressive kyphosis adjacent to the fusion are difficult to address with instrumentation alone.

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